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Letters |

Optical Coherence Tomography for Optic Disc Edema—Reply

Randy H. Kardon, MD, PhD; Colin J. Scott, MD; Andrew G. Lee, MD; Lars Frisén, MD, PhD; Michael Wall, MD
Arch Ophthalmol. 2011;129(9):1245-1247. doi:10.1001/archophthalmol.2011.283.
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We thank Savini and colleagues for their interesting comments regarding our article.1 They inquire about what effect papilledema had on features of OCT in the outer layers of the retina in our data set of patients with various grades of papilledema. Their inquiry has origin in their own observations of a “hyporeflective subretinal space” in time-domain B scans obtained using OCT (Stratus OCT; Zeiss Meditech, Dublin, California) of patients with papilledema2 and also analyzed in an article by Johnson et al3 identifying OCT characteristics that may differentiate papilledema from pseudopapilledema. While the authors are not certain about the cause of the observed hyporeflective subretinal space, they are of the opinion that it may represent an important structural feature of papilledema and wondered why we did not report on this feature in our study.

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Figure 1. Spearman correlation between the thickness of the retinal nerve fiber layer in eyes with papilledema vs the grade of thickness of the hyporeflective subretinal space on optical coherence tomography (OCT) in eyes in which there was obvious fluid present. Spearman correlation = 0.875; P = .001.

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Figure 2. Patient with acute central retinal artery occlusion in the right eye on July 19, 2007, demonstrating increased thickness and reflectivity of the retinal nerve fiber layer due to retinal edema and associated subretinal hyporeflective dark space by time-domain optical coherence tomography. With time, as the retinal edema resolves, so does the thickness of the hyporeflective space.

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Figure 3. Patient with myelinated retinal nerve fiber layer superiorly, nasally, and inferiorly (A) with corresponding B scan of Stratus optical coherence tomographic circular peripapillary scan (B). Note the higher reflectivity of the retinal nerve fiber layer in the peripapillary nasal area of the optical coherence tomographic scan (middle one third of B scan) and corresponding increase in hyporeflectivity in the outer retina directly underlying the myelinated region (arrows).

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September 1, 2011
Giacomo Savini, MD; Piero Barboni, MD; Michele Carbonelli, MD; Valerio Carelli, MD, PhD; Alfredo A. Sadun, MD, PhD
Arch Ophthalmol. 2011;129(9):1245-1247. doi:10.1001/archophthalmol.2011.282.
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